Toward the Deimplementation of Computed Tomography Urogram for Patients With Low- to Intermediate-risk Microscopic Hematuria: A Mixed-method Study of Factors Influencing Continued Use.

Autor:	Birken SA; Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina., Matulewicz R; Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, New York., Pathak R; Department of Urology, Mayo Clinic, Rochester, Minnesota., Wagi CR; Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina., Peluso AG; Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina., Bundy R; Department of Internal Medicine, Informatics and Analytics, Wake Forest University School of Medicine, Winston-Salem, North Carolina., Witek L; Department of Internal Medicine, Informatics and Analytics, Wake Forest University School of Medicine, Winston-Salem, North Carolina., Krol B; Wake Forest University School of Medicine, Winston-Salem, North Carolina., Parchman ML; Kaiser Permanente Washington Health Research Institute, Seattle, Washington., Nielsen M; Department of Urology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina., Dharod A; Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina.; Department of Internal Medicine, Informatics and Analytics, Wake Forest University School of Medicine, Winston-Salem, North Carolina.; Wake Forest University School of Medicine, Department of Internal Medicine (IM), Section on General Internal Medicine (GIM), Winston-Salem, North Carolina.; Wake Forest Center for Healthcare Innovation (CHI), Winston-Salem, North Carolina.; Wake Forest Center for Biomedical Informatics (WFBMI), Winston-Salem, North Carolina.
Jazyk:	angličtina
Zdroj:	Urology practice [Urol Pract] 2023 Sep; Vol. 10 (5), pp. 511-519. Date of Electronic Publication: 2023 Jul 03.
DOI:	10.1097/UPJ.0000000000000429
Abstrakt:	Introduction: Citing high costs, limited diagnostic benefit, and ionizing radiation-associated risk from CT urogram, in 2020 the AUA revised its guidelines from recommending CT urogram for all patients with microscopic hematuria to a deintensified risk-stratified approach, including the deimplementation of low-value CT urogram (ie, not recommending CT urogram for patients with low- to intermediate-risk microscopic hematuria). Adherence to revised guidelines and reasons for continued low-value CT urogram are unknown. Methods: With the overarching objective of improving guideline implementation, we used a mixed-method convergent explanatory design with electronic health record data for a retrospective cohort at a single academic tertiary medical center in the southeastern United States and semistructured interviews with urology and nonurology providers to describe determinants of low-value CT urogram following guideline revision. Results: Of 391 patients with microscopic hematuria, 198 (51%) had a low-value CT urogram (136 [69%] pre-guideline revision, 62 [31%] postrevision). The odds of ordering a low-value CT urogram were lower after guideline revisions, but the change was not statistically significant (OR: 0.44, P = .08); odds were 1.89 higher ( P = .06) among nonurology providers than urology providers, but the difference was not statistically significant. Provider interviews suggested low-value CT urogram related to nonurology providers' limited awareness of revised guidelines, the role of clinical judgment in microscopic hematuria evaluation, and professional and patient influences. Conclusions: Our findings suggest low-value CT urogram deimplementation may be improved with guidelines and implementation support directed at both urology and nonurology providers and algorithms to support guideline-concordant microscopic hematuria evaluation approaches. Future studies should test these strategies.
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu